Electrochromatographic behavior of silica monolithic capillaries of different skeleton sizes synthesized with a simplified and shortened sol-gel procedure.
Silica monolithic capillaries (SMCs) were synthesized by a sol-gel process. First, a simplification of the synthesis was proposed by replacing the calcination and the drying steps which can have tremendous effects on chromatographic and physical properties, by a single water or methanol 2 h washing step. The efficiency of such a washing step was demonstrated and the comparison of the chromatographic and electrochromatographic properties between calcined and washed SMCs has shown that such a modification did not impair retention, efficiency, and stability of the monolith. This simplified procedure was carried out to synthesize SMCs with two different skeleton sizes. These capillaries were evaluated in electrochromatography and present high efficiencies (H = 5 microm) at least equal to the best ones reported in the literature. Furthermore, the influence of the skeleton size on the EOF of the second kind (EOF-2) was investigated with unmodified SMCs used under various experimental conditions including electrical field strength and buffer concentration. The ionic strength of the mobile phase and the applied electrical field that enable this EOF-2 were related to the size of the skeleton which was tuned by the synthesis conditions.


Oncostatin M stimulates the expression and release of the IL-6 receptor in human hepatoma HepG2 cells.
Soluble IL-6R (sIL-6R), which lacks the transmembrane domain, has been suggested to be a potent immunomodulator of IL-6 biologic activity. In this study, the ability of cells of hepatic origin to generate the sIL-6R was investigated. It was found that oncostatin M alone or in combination with the glucocorticoid analogue dexamethasone significantly up-regulated IL-6R release. Oncostatin M appeared to generate the sIL-6R primarily through an alternative splicing mechanism. Since sIL-6R is able to form biologically active complexes with IL-6, the release of the sIL-6R from hepatocytes may be important to sensitize cells lacking the membrane-bound receptor, particularly during an acute phase reaction.


Chromosomal disorders associated with epilepsy.
Epilepsy is among the most common findings associated with chromosome aberrations, particularly those involving autosomal chromosome imbalances. Most chromosome aberrations can be associated with different seizure types, but there are a few aberrations featuring specific seizure and electroencephalographic (EEG) patterns. The analysis of electro-clinical patterns associated with chromosomal aberrations is a major tool in the identification of epilepsy susceptibility genes. Advances in molecular cytogenetic techniques will certainly increase the diagnostic yield, and an increasing number of individuals previously diagnosed as having "cryptogenic" epilepsy will turn out to have an underlying chromosomal aberration. We review the types of seizures, EEG findings, and their natural history in the chromosomal disorders that are consistently associated with epilepsy.


Immunochemical studies in Wilson's disease.
The present study deals with a total of 28 cases of Wilson's disease, 50 normal individuals alongwith siblings and parents of eight cases. Male predominance (18 out of 28 cases), a median age of 11 years and universal presence of Kayser-Fleischer (K. F.) ring marked the cardinal features. Furthermore, 11 patients had hepatic-neural presentation while two had only the K. F. Ring without clinical abnormality. Single Radial Immunodiffusion (SRID) as the absolute quantitative procedure revealed a profound deficiency of ceruloplasmin with the levels ranging anywhere between 0.5 mg/dI to 23 mg/dI amongst the patients of Wilson's disease. The data from siblings and parents also revealed deficiency in 15 out of 23 serum samples when subjected to disc electrophoresis-benzidine screening procedure.


The NanoZoomer artificial intelligence connectomics pipeline for tracer injection studies of the marmoset brain.
We describe our connectomics pipeline for processing anterograde tracer injection data for the brain of the common marmoset (Callithrix jacchus). Brain sections were imaged using a batch slide scanner (NanoZoomer 2.0-HT) and we used artificial intelligence to precisely segment the tracer signal from the background in the fluorescence images. The shape of each brain was reconstructed by reference to a block-face and all data were mapped into a common 3D brain space with atlas and 2D cortical flat map. To overcome the effect of using a single template atlas to specify cortical boundaries, brains were cyto- and myelo-architectonically annotated to create individual 3D atlases. Registration between the individual and common brain cortical boundaries in the flat map space was done to absorb the variation of each brain and precisely map all tracer injection data into one cortical brain space. We describe the methodology of our pipeline and analyze the accuracy of our tracer segmentation and brain registration approaches. Results show our pipeline can successfully process and normalize tracer injection experiments into a common space, making it suitable for large-scale connectomics studies with a focus on the cerebral cortex.


The kynurenine 3-hydroxylase inhibitor Ro 61-8048 improves dystonia in a genetic model of paroxysmal dyskinesia.
The effects of the novel kynurenine 3-hydroxylase inhibitor 3,4-dimethoxy-N-[4-(3-nitrophenyl)thiazol-2-yl]benzenesulfonamide (Ro 61-8048) on severity of dystonia were examined in dt(sz) mutant hamsters, an animal model of paroxysmal dystonia, in which stress precipitates dystonic episodes. Ro 61-8048 (50, 100 and 150 mg/kg i.p.) significantly reduced the severity of dystonia in dt(sz) hamsters without leading to marked central side effects. Determinations of kynurenic acid concentrations in brain homogenates demonstrated that Ro 61-8048 (100 mg/kg i.p.) provoked a two- to threefold increase of the endogeneous broad spectrum glutamate receptor antagonist kynurenic acid in the striatum, cerebellum and brainstem of mutant hamsters. The antidystonic efficacy of Ro 61-8048 at well-tolerated doses suggests that kynurenine 3-hydroxylase inhibitors should be considered as new therapeutic candidates for the treatment of dyskinesias.


Handwashing in 51 Countries: Analysis of Proxy Measures of Handwashing Behavior in Multiple Indicator Cluster Surveys and Demographic and Health Surveys, 2010-2013.
In 2009, a common set of questions addressing handwashing behavior was introduced into nationally representative Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), providing large amounts of comparable data from numerous countries worldwide. The objective of this analysis is to describe global handwashing patterns using two proxy indicators for handwashing behavior from 51 DHS and MICS surveys conducted in 2010-2013: availability of soap anywhere in the dwelling and access to a handwashing place with soap and water. Data were also examined across geographic regions, wealth quintiles, and rural versus urban settings. We found large disparities for both indicators across regions, and even among countries within the same World Health Organization region. Within countries, households in lower wealth quintiles and in rural areas were less likely to have soap anywhere in the dwelling and at designated handwashing locations than households in higher wealth quintiles and urban areas. In addition, disparities existed among various geographic regions within countries. This analysis demonstrates the need to promote access to handwashing materials and placement at handwashing locations in the dwelling, particularly in poorer, rural areas where children are more vulnerable to handwashing-preventable syndromes such as pneumonia and diarrhea.


Familial adult-onset Pompe disease associated with unusual clinical and histological features.
The adult-onset form of Pompe disease had a wide clinical spectrum, ranging from asymptomatic patients with increased CK to muscle cramps and pain syndrome or rigid-spine syndrome. In addition clinical severity and disease progression are greatly variable. We report on a family with 3 siblings characterized by an unusual adult-onset Pompe disease including dysphagia and weakness of tongue, axial and limb-girdle muscles, in association with atypical globular inclusions in muscle fibres. Our study confirms the great clinical and histological variability of adult-onset Pompe disease and further supports the need of careful evaluation of bulbar function in patients affected by this pathology.


[A case of McLeod syndrome].
A 52-year-old man was admitted to our hospital in 1997 because of high serum creatine kinase (CK) level. Neurologic findings revealed chorea on the trunk and extremities, mild weakness of proximal muscles, and absence of deep tendon reflexes in four extremities. Serum CK was elevated to 3,494 U/l (normal, below 235). A peripheral blood smear showed acanthocytes in approximately 1% of the red blood cells (RBCs). Very weak expression of the Kell antigens (K2, K4, K5, and K7) on his RBCs led us to make a final diagnosis of McLeod syndrome. Muscle biopsy from the left biceps showed increased variability in fiber diameter, a few regenerating fibers, scattered fibers with internal nuclei, and mild fiber type grouping. Immunohistochemical analyses of dystrophin. merosin, and adhalin were normal. Although McLeod syndrome is a rare X-linked recessive disorder, it is clinically important for differential diagnosis of chorea acanthocytosis and hyperCKemia.


Cardiac Troponin I and Amino-Terminal Pro B-Type Natriuretic Peptide in Dogs With Stable Chronic Kidney Disease.
Increased concentrations of N-terminal pro B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) in dogs with azotemia have been documented. Knowledge of mechanisms behind increased concentrations of cardiac biomarkers in dogs with azotemia is warranted for correct interpretation of test results. The aim of the article was to investigate possible associations between plasma concentrations of cTnI and NT-proBNP, respectively, and patient characteristics, glomerular filtration rate (GFR), a plasma volume factor (PVF) derived from scintigraphic examination (PVf), systolic blood pressure (SBP), selected hematologic and biochemical variables, and echocardiographic measurements in dogs with stable chronic kidney disease (CKD) and in healthy dogs. Fifty student-, staff-, and client-owned dogs were included. Twenty-three of the dogs were healthy and 27 were diagnosed with CKD. In this cross-sectional observational study, dogs with a previous diagnosis of CKD and healthy control dogs were included. At inclusion, all dogs were characterized by physical examination, repeated blood pressure measurements, complete urinalysis, hematology and biochemistry panel, echocardiography, abdominal ultrasound examination of the entire urinary tract, and scintigraphic examination for measurement of GFR. Plasma volume factor and PCV were independently associated with NT-proBNP (Radj2 = 0.42; P < .0001). Age, body weight (BW), and SBP were independently associated with cTnI (Radj2 = 0.50; P < .0001). Neither NT-proBNP nor cTnI concentrations were independently associated with measured GFR. Thus, findings were not suggestive of passive accumulation of either marker, suggesting that increased circulating concentrations of cTnI and NT-proBNP can be interpreted similarly in dogs with stable CKD as in dogs without CKD.


Assessing internalizing, externalizing, and attention problems in young children: validation of the MacArthur HBQ.
To test the validity of the MacArthur Health and Behavior Questionnaire (HBQ) using receiver operating characteristic (ROC) analysis to determine optimal thresholds for the HBQ in predicting Diagnostic Interview Schedule for Children Version-IV (DISC-IV) diagnoses. The roles of child sex, level of impairment, and physical health in understanding of psychopathology were also considered. A sample of 814 8-year-old twin children was recruited from birth records. Mothers were interviewed over the telephone using the HBQ and were also interviewed in person using the DISC-IV. Fathers also completed the HBQ; children completed the parallel module of the Berkeley Puppet Interview. The HBQ identified more cases overall than the DISC-IV. Sex did not contribute to prediction of diagnosis. Impairment, DISC-IV symptom counts, father HBQ, child Berkeley Puppet Interview, and physical health significantly distinguished the HBQ low and high symptom groups. The HBQ is a valid new screening measure of psychopathology for use with children under 9 years of age. It is sensitive to internalizing disorders, which may aid the understanding of depression and anxiety disorders that are often underappreciated in young children.


A single-chip multi-beam steering optical phased array: design rules and simulations.
A waveguide-based multi-beam steering device is proposed for light detection and ranging (LIDAR). The device integrates binary gratings with an optical phased array (OPA), thus enabling a single-chip LIDAR system. The device can provide an N×M beam array that covers a wide angular range while phase shifters help realize steering over a narrow angle range between the beams. The antenna structure for 1D beam splitting is realized by combining the design of a grating coupler and a beam splitter grating, and a uniform beam splitting is achieved along the other dimension using non-uniformly distributed antennas. To illustrate the design, an OPA with an 11×11 beam array is designed at a wavelength of 905 nm. The OPA achieves a wide total field of view (FOV) of 68.8° × 77° with a narrow beam-array-steering angle of 6.5°, enabling a wide-FOV 3D sensing with a high frame rate.


Rapid identification of bacteria from bioMérieux BacT/ALERT blood culture bottles by MALDI-TOF MS.
Several studies have reported poor results when trying to identify microorganisms directly from the bioMérieux BacT/ALERT blood culture system using matrix-assisted laser desorption/ionisation-time of flight (MALDI-TOF) mass spectrometry. The aim of this study is to evaluate two new methods, Sepsityper and an enrichment method for direct identification of microorganisms from this system. For both methods the samples were processed using the Bruker Microflex LT mass spectrometer (Biotyper) using the Microflex Control software to obtain spectra. The results from direct analysis were compared with those obtained by subculture and subsequent identification. A total of 350 positive blood cultures were processed simultaneously by the two methods. Fifty-three cultures were polymocrobial or failed to grow any organism on subculture, and these results were not included as there was either no subculture result, or for polymicrobial cultures it was known that the Biotyper would not be able to distinguish the constituent organisms correctly. Overall, the results showed that, contrary to previous reports, it is possible to identify bacteria directly from bioMérieux blood culture bottles, as 219/297 (74%) correct identifications were obtained using the Bruker Sepsityper method and 228/297 (77%) were obtained for the enrichment method when there is only one organism was present. Although the enrichment method was simpler, the reagent costs for the Sepsityper method were approximately pound 4.00 per sample compared to pound 0.50. An even simpler and cheaper method, which was less labour-intensive and did not require further reagents, was investigated. Seventy-seven specimens from positive signalled blood cultures were analysed by inoculating prewarmed blood agar plates and analysing any growth after 1-, 2- and 4-h periods of incubation at 37 degrees C, by either direct transfer or alcohol extraction. This method gave the highest number of correct identifications, 66/77 (86%), and was cheaper and less labour-intensive than either of the two above methods.


Effect of inositol starvation on the in vitro syntheses of mannan and N-acetylglucosaminylpyrophosphoryldolichol in Saccharomyces cerevisiae.
An early consequence of starvation for inositol in yeast is inhibition of synthesis of the major cell wall components mannan and glucan. In looking for the mechanism of this inhibition, we found that the activity of the enzyme catalyzing the synthesis of N-acetylglucosaminylpyrophosphoryldolichol was diminished in particular membrane preparations from cells starved for inositol. This loss of reactivity was observed under a variety of in vitro assay conditions and could be restored by the addition of phosphatidylinositol but not by other phosphoinositol-containing sphingolipids known to occur in yeast. When assayed in the presence of high concentrations of Triton X-100, enzyme preparations from both control and inositol-starved cells required phosphatidylinositol for maximal activity. Since this enzyme catalyzed an early step in the synthesis of mannan that is N-linked to protein, a reasonable hypothesis is that inhibition of mannan synthesis in inositol-starved cells results from the depletion of the necessary cofactor phosphatidylinositol.


Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis.
Tegumentary leishmaniasis, comprising the cutaneous and mucocutaneous forms, is caused by at least 13 dermotropic species of protozoa of the genus Leishmania, most of which are prevalent in the New World. Although diseases in the Old and New Worlds share similar characteristics, the ultimate manifestations and severity are quite different, with more severe forms associated with mucosal lesions observed in the New World. For the diagnosis and treatment of leishmaniasis, differences based on clinical features, usefulness/sensitivity of diagnostic methods and therapeutic responses are mainly emphasized. We present a critical review of the diagnostic methods, their contribution and the necessity for their improvement/development, particularly in molecular diagnosis aimed at detection and species identification, as well as serodiagnosis. In addition to a review of the drugs currently utilized, we describe differences in their effectiveness in Old and New World leishmaniasis. HIV/Leishmania coinfection is also presented in the context of diagnosis and treatment.


A modified activity protocol for claudication.
We propose the use of a monitored step tracking device, the FitBit® to supplant supervised exercise therapy (SET) programs to facilitate improvement in walking distance in veteran claudicators. In this prospective study, we enrolled forty-nine patients with clinical evidence of lower extremity claudication in a six-month walking program. Each patient was given a FitBit® device to track daily number of steps. Patients were seen in clinic monthly to collect data and discuss walking goals. Surveys at the beginning and end of each study assessed patient perception of changes in walking distance as well as symptoms. The primary outcome was monthly distance walked. Changes over time in each outcome variables were examined using a random effects mixed model. In the first month, the adjusted mean number of steps per day was 3492 (95% CI: 2661-4322). By month 5, this had increased to 4502 (3636-5367) (P=0.0007). Twenty-eight patients used the tracker at least for 1 month, while 21 (43%) did not. Being bothered by symptoms was the only patient variable that was significantly associated with use of the FitBit®. Those who used the tracker tended to be younger, heavier, more active, and were more likely to have diabetes. In the veteran population, the use of a monitored step tracking device such as the FitBit® is a potentially effective strategy to improve walking distance in claudicators particularly in those with mild symptoms. Additional investigation is needed to determine which patients will benefit most from this walking protocol.


The ER chaperone, BIP protects Microglia from ER stress-mediated Apoptosis in Hyperglycemia.
A major endoplasmic reticulum (ER) chaperone, binding of Immunoglobulin heavy chain protein (BIP) facilitates the assembly of newly synthesized proteins in the ER. Microglia vigorously respond to brain injuries and eliminate the damaged neuronal and apoptotic cells through phagocytosis in the central nervous system. However, the mechanism of BIP-mediated microglial function is not clear in hyperglycemia. We explored the molecular mechanism of BIP in microglial function during hyperglycemic conditions. Hyperglycemia was induced in mice by two consecutive intraperitoneal injections of streptozotocin (STZ 100/kg) and confirmed by measuring the blood glucose from day 2 to day 14. After 14 days of experimental hyperglycemia, mice were sacrificed and brains were collected for ER chaperone expression. In-vitro hyperglycemia was induced by exposing HMC3 cells to 25 mM glucose for 5 days and proteins involved in ER stress, apoptosis, and autophagy were analyzed. In hyperglycemic conditions, BIP protein expression was dramatically reduced in HMC3 cells, which led to increased apoptosis through the activation of CHOP and mitochondrial pro-apoptotic proteins (Bax, Bad, and cleaved caspase-3). The flow cytometry results indicate hyperglycemia-induced apoptosis and reactive oxygen species (ROS) production. Interestingly, the BIP inducer X restored the apoptosis in HMC3 cells by derepressing BIP expression and inhibiting ER stress. These results suggest that the ER chaperone BIP is required for the microglial function and protects from apoptosis in hyperglycemia. A better understanding of BIP's molecular mechanism and role in microglial function may contribute to developing novel therapies for microglia dysfunction-associated neurodegenerative diseases.


Nitrous oxide (N2O) prevents latent pain sensitization and long-term anxiety-like behavior in pain and opioid-experienced rats.
Improving rehabilitation after a severe tissue injury does not only require a reduction in pain, but also requires alleviation of negative affects, particularly anxiety. Although opioids remain unsurpassed analgesics to relieve moderate to severe pain, it has been shown that they also induce latent pain sensitization leading to long-lasting hyperalgesia via N-methyl-D-aspartate-(NMDA)-dependent pronociceptive systems. The present study evaluated the ability of nitrous oxide (N2O), a gas with NMDA antagonist properties, to prevent latent pain sensitization and long-term anxiety-like behavior (ALB) in rats with pain and opioid experiences. On D0, the pro-inflammatory drug carrageenan was injected in one hind paw of rats treated with fentanyl (4x100 microg/kg subcutaneously). Nociceptive threshold was evaluated with the paw pressure vocalization test. Rats were re-exposed to carrageenan or exposed to repeated non-nociceptive environmental stress (NNES) 2-3 weeks later. Rats were also challenged in the elevated plus-maze 2 weeks after fentanyl administration for evaluating ALB. The preventive effects of a single 4 h 50/50% N2O-O2 exposure performed on D0 was evaluated. Fifty percent N2O strongly reduced hyperalgesia induced by a first inflammation and its enhancement by fentanyl, and prevented exaggerated hyperalgesia induced by second inflammatory pain or NNES. Moreover, we provide first evidence that a high fentanyl dose induces long-term ALB 2 weeks after its administration. When associated with fentanyl, 50% N2O prevented such long-term ALB. These results suggest that a single exposure to N2O could improve post-injury pain management and facilitate rehabilitation especially when potent analgesics as opioids have to be used.


Is Open Visitation Really "Open" in Adult Intensive Care Units in the United States?
Evidence indicates that open visitation in adult intensive care units is a best practice for patient- and family-centered care, and nurses substantially influence such visitation patterns. However, it is unclear whether intensive care units in Magnet and Pathway to Excellence (MPE) facilities nationwide implement this in practice. To describe current national visitation practices in adult intensive care units and determine whether they have changed since the last national study, which used data from 2008 to 2009. From February through April 2018, websites of MPE hospitals were reviewed in order to identify their adult intensive care unit visitation policy. If this information was unavailable online, the hospital was telephoned to obtain the policy. From May through August 2018, follow-up telephone calls were made to hospitals that reported open visitation, during which intensive care unit nurses at the hospitals were asked to verify that the policy did not restrict visiting hours or the number, type, or age of visitors. Among the 536 MPE hospitals contacted, 51% (n = 274) indicated that they allowed open visitation. Further examination, however, revealed that 64% (n = 175) restricted the number (68.2%), age (59.5%), or type (4.4%) of visitors, or visiting hours (19.8%). Only 18.5% of MPE hospitals (n = 99) allowed unrestricted visitation. This study suggests a lack of progress toward implementing open visitation in adult intensive care units nationwide. Research on MPE hospitals that have adopted truly open visitation policies is needed to identify successful methods for implementing and sustaining open visitation.


Shared alterations in NK cell frequency, phenotype, and function in chronic human immunodeficiency virus and hepatitis C virus infections.
Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) cause clinically important persistent infections. The effects of virus persistence on innate immunity, including NK cell responses, and the underlying mechanisms are not fully understood. We examined the frequency, phenotype, and function of peripheral blood CD3- CD56+ NK subsets in HIV+ and HCV+ patients and identified significantly reduced numbers of total NK cells and a striking shift in NK subsets, with a marked decrease in the CD56(dim) cell fraction compared to CD56(bright) cells, in both infections. This shift influenced the phenotype and functional capacity (gamma interferon production, killing) of the total NK pool. In addition, abnormalities in the functional capacity of the CD56(dim) NK subset were observed in HIV+ patients. The shared NK alterations were found to be associated with a significant reduction in serum levels of the innate cytokine interleukin 15 (IL-15). In vitro stimulation with IL-15 rescued NK cells of HIV+ and HCV+ patients from apoptosis and enhanced proliferation and functional activity. We hypothesize that the reduced levels of IL-15 present in the serum during HIV and HCV infections might impact NK cell homeostasis, contributing to the common alterations of the NK pool observed in these unrelated infections.


[Short-term triple therapy with pantoprazole, amoxicillin and metronidazole in Helicobacter pylori infection].
The present study was conducted to investigate the efficacy and tolerability of a 7-day treatment with pantoprazole, amoxicillin and metronidazole for the eradication of Helicobacter pylori (H. pylori) infection. Fifty patients (26 male, 24 female, age 18 to 86, mean 54 years) with an active duodenal (n = 25) or gastric ulcer (n = 25) were recruited into the study, 48 patients being H. pylori positive at the study start. Patients were treated with pantoprazole (40 mg bid), amoxicillin (1 g bid) and metronidazole (500 mg bid) for 7 days and for another 21 days with pantoprazole (40 mg/od). Four weeks after the end of study medications the patients were re-examined endoscopically and their H. pylori status was re-assessed using urease test, histology and 13C-urea-breath test. In 39 of 48 intention to treat patients, H. pylori infection was cured, according to 81% (95%-CI = 67 to 91%). In the per protocol population in 35 of 41 patients H. pylori was eradicated, which results in an eradication rate of 85% (95%-CI = 71 to 94%). Ulcer healing was endoscopically confirmed in 45 of 48 patients (94%; 95%-CI = 83 to 99%) after 8 weeks. Six of 50 patients (12%) reported mild to moderate probable side-effects of the study medication. Cure of the infection was associated with a distinct reduction of the gastritis grade and activity. A 7-day triple therapy using pantoprazole, amoxicillin and metronidazole is an effective and cost-effective alternative to regimens including clarithromycin for the treatment of H. pylori infection.


Evaluation of the Behavioral Determinants of Infant Oral Hygiene Practices in a Rural Area.
Background Dental caries is one of the most common oral health diseases in children. Early childhood caries (ECC) in children can lead to delayed overall growth in the future. This can be prevented by early initiation of infant oral hygiene practices (IOHP). As mothers are the primary caregivers, assessing their behavioral factors that play a significant role in IOHP can help design a customized health prevention plan for appropriate infant oral hygiene practices. Methodology A questionnaire based-study was carried out in an Anganwadi (rural child care center in India) of Nagpur region, Central India, for two months. Parents of young children were interviewed about the oral health care of children. The study was planned to evaluate the various methods used by parents to perform IOHP and to identify various behavioral determinants that affect IOHP. An integrative model of behavior change was used to evaluate factors determining the behavioral determinants in performing oral hygiene. Results Out of 144 parents, 105 (72.92%) initiated IOHP immediately after birth. Most of them (76, 52.78%) used a moist cloth to clean the oral cavity. The other methods used were the parent's finger, water, etc. Most of the parents were unaware of commercially available oral wipes. Out of the various factors of behavioral determinants of integrative theory, oral health beliefs, emotional reactions, self-standard, and skills played a significant role in modifying parents' intention to maintain the oral hygiene of young children. There was a direct correlation between the educational qualification of the mother and oral hygiene practices. Conclusion The results of this study reveal an integrative structure that includes factors like oral health beliefs, emotional reactions, self-standard, external support, social norms, and skills that are responsible for the behavior of parents towards oral health care. These factors vary from individual to individual. Modifying these specific behavioral determinants in parents could improve the oral hygiene practices of infants and toddlers. Community-based oral health care programs should be tailormade to target these specific barriers.


Myopotential interference with DDD pacemakers: endocardial electrographic telemetry in the diagnosis of pacemaker-related arrhythmias.
Skeletal myopotentials may inhibit the output of unipolar demand ventricular pacemakers, resulting in protracted episodes of asystole in susceptible patients. The new DDD-mode pacemakers have, in addition to a unipolar ventricular lead, a unipolar atrial lead to enable atrioventricular sequential or atrial synchronous function. During clinical investigation of a new dual-unipolar cardiac pacing system programmed to operate in the DDD mode (Pacesetter AFP models 281 and 283), 6 patients were noted (5 men and 1 woman, aged 22 to 68 years) who manifested paroxysmal acceleration of ventricular pacing rate approaching the maximal tracking rate. Two patients also had abrupt slowing or cessation of ventricular output. With the use of atrial electrographic recordings (obtained with telemetry), the following mechanisms of rate change were found: myopotential tracking, myopotential inhibition, interference-mode asynchronous operation, sudden increases in sinus rate, and pacemaker-mediated reentrant tachycardia. In all patients, reprogramming of the implanted devices, based on telemetered atrial electrography, resulted in disappearance of the arrhythmias and loss of symptoms while maintaining the DDD pacing mode. Thus, several mechanisms of rhythm disturbances are peculiar to dual-chamber cardiac pacing systems that use unipolar electrodes. Endocardial telemetry combined with extensive programming capability offers the best opportunity for proper diagnosis and management of these problems.


[Psychodermatology: a collaboration between psychiatry and dermatology].
Dermatology is of special importance in consultation-liaison practice. The brain and the skin originate from the same germ layer, the ectoderm, in the embryo. In later periods of life, the various ways these two organs influence each other has been the subject of many studies published in this field. These studies are divided into three groups: 1- studies about stress and dermatologic diseases, 2- psychoanalytic and psychodynamic approaches to psychodermatologic diseases, and 3- clinical research and treatment of psychodermatologic diseases. Recently, in some countries which are aware of the importance of the subject, in the psychodermatology section psychiatrists, dermatologists, psychologists and residents work together as a team. In fact, it has been already accepted that there is a need for association between psychiatry and dermatology in many cases. This association between the two disciplines aims to enhance the success of therapy and psychiatric support for patients who primarily have psychiatric disease, but project that as a dermatologic disease, on the one hand. On the other hand, it provides a more holistic, and satisfying approach for both doctors and patients having primarily dermatologic disease, but who develop psychiatric problems secondarily. In this article, psychodermatology investigations and the relationship between the skin and psyche, diseases discussed in this context, and overlapping areas of psychiatry and dermatology are reviewed, and it is aimed to attract attention to this topic.


High-throughput and facile assay of antimicrobial peptides using pH-controlled fluorescence resonance energy transfer.
Amphipathic antimicrobial peptides can destroy bacteria cells by inducing membrane permeabilization, forming one strategy for innate defense by various organisms. However, although the antimicrobial peptides are considered a promising alternative for use against multidrug-resistant bacteria, large-scale screening of potential candidate antimicrobial peptides will require a simple, rapid assay for antimicrobial activity. Here, we describe a novel fluorescence resonance energy transfer (FRET)-based assay system for antimicrobial peptides which takes advantage of pH-related changes in FRET efficiency due to the instability of enhanced yellow fluorescent protein versus the stability of enhanced cyan fluorescent protein in a reduced-pH environment. We successfully showed that quantification of antimicrobial activity is possible through a difference of FRET efficiency between ECFP-EYFP fusion molecules released from disrupted Escherichia coli in an extracellular environment (pH 6) and those retained in an intracellular environment (pH approximately 7). Thus, we herein suggest a new simple, effective, and efficient pH-controlled FRET-based antimicrobial peptide screening method applicable to high-throughput screening of candidate peptide libraries.


Analysis of pharmacokinetic data using parametric models--1: Regression models.
This is the first in a series of tutorial articles discussing the analysis of pharmacokinetic data using parametric models. In this article, the purposes of modelling are discussed; regression models for individuals and populations are defined; and structural and variance models are discussed as the two required submodels of the overall regression model. Topics of future articles are: point estimates of parameters; interval estimates of parameters; model criticism and choosing among contending models; population kinetic models and estimation; and elements of optimal design.


Somatostatin-like immunoreactivity in the brain of an electric fish (Apteronotus leptorhynchus) identified with monoclonal antibodies.
The immunohistochemical localization of somatostatin-like immunoreactive (SSir) cells and fibers in the brain of the gymnotiform teleost (Apteronotus leptorhynchus) was investigated using well-characterized monoclonal antibodies directed against somatostatin-14 and -28. Large populations of SSir neurons occur in the basal forebrain, diencephalon and rhombencephalon and a dense distribution of fibers and terminal fields is found in the ventral, dorsomedial and dorsolateral telencephalon, hypothalamus, centralis posterior thalamus, subtrigeminal nucleus, the motor nucleus of vagus and in the ventrolateral medulla. Immunoreactive neurons in the forebrain are concentrated mainly in the ventral telencephalic areas, the region of the anterior commissure and entopeduncular nucleus. In a fashion similar to the large basal telencephalic cells of other species, the cells of the rostral nucleus entopeduncularis have a significant projection to the dorsal telencephalon. The preoptic region and the peri- and paraventricular hypothalamic nuclei are richly endowed with SSir cells; some of these cells contribute fibres to the pituitary stalk and gland. In the thalamus, only the n. centralis posterior stands out for the density of SSir cells and terminals; these cells appear to project to the prepacemaker nucleus, thus suggesting an SS influence on electrocommunication. In the mesencephalon most SSir cells occur in the optic tectum, torus semicircularis and interpeduncular nucleus. The rhombencephalic SSir cells have a wider distribution (central gray, raphe, sensory nuclei, reticular formation, electrosensory lateral line lobe and surrounding the central canal). The results of this study show the presence of SS in various sensory systems, electromotor system and specific hypothalamic nuclei, suggesting a modulatory role in the processing of sensory information, electrocommunication, endocrine and motor activities.


Bacteroides-associated pylephlebitis in a patient with strongyloidiasis.
Strongyloidiasis is associated with Gram-negative bacteremia. Septic portal vein thrombosis or pylephlebitis is a rare but serious complication of intra-abdominal infection, and it is often associated with Bacteroides bacteremia. We present the first report of pylephlebitis with Bacteroides bacteremia associated with underlying Strongyloides stercoralis infection and briefly review the management of septic portal vein thrombosis.


[West's syndrome. Analysis, aetiological factors and therapeutic options].
West's syndrome (WS), which is also known as infantile myoclonic encephalopathy with hypsarrhythmia, is one of the generalized epileptic syndromes with a cryptogenic or symptomatic origin. It is an age-dependent epileptic syndrome. The latest neuroimaging techniques have enabled us to gain a better understanding of its physiopathology and to identify new aetiological factors responsible for the clinical symptoms. WS can be due to a number of aetiologies, the most notable of which are congenital errors of metabolism. The incidence of cases due to phenylketonuria or hypoglycaemia is currently diminishing, yet, there is a rise in the number of new metabolic diseases that are responsible for the symptoms of WS. These include the carbohydrate-deficient glycoprotein syndromes or biotinidase deficiency. In all cases, and especially so in those that are idiopathic, it is wise to conduct exhaustive aetiological studies, since on some occasions metabolic diseases will be shown to be responsible, and this will then modify the prognosis, therapy and genetic counselling. It is important to have a protocol for both study and therapy available for this syndrome. The therapeutic options available can be implemented after ruling out a neurometabolic disease as being responsible for the syndrome and quickly beginning treatment with vigabatrine, sodium valproate plus pyridoxine, ACTH or hydrocortisone. If there is no response then topiramate can be used. Other therapeutic options, such as the use of zonisamide, a ketogenic diet or even surgical treatment, are also analyzed.


Mediators of change in online mindfulness-based cognitive therapy: A secondary analysis of a randomized trial of mindful mood balance.
Digital delivery of mindfulness-based cognitive therapy through the Mindful Mood Balance (MMB) program is clinically effective (Segal et al., 2020); however, the mechanisms through which this program delivers its benefits have not been established. This study investigates the differential impact of the MMB program paired with usual depression care (UDC) compared to UDC alone on the putative targets of self-reported mindfulness, decentering, and rumination and the extent to which change in these targets mediates subsequent depressive relapse among a sample of predominantly White, female participants, with residual depressive symptoms. The MMB program relative to UDC was associated with a significantly greater rate of change in decentering (t = 4.94, p < .0001, d = 0.46), mindfulness (t = 6.04, p < .0001, d = 0.56), and rumination (t = 3.82, p < .0001, d = 0.36). Subsequent depressive relapse also was mediated by prior change in these putative targets, with a significant natural indirect effect for decentering, χ2(1) = 7.25, p < .008, OR = 0.57; mindfulness, χ2(1) = 9.99, p < .002, OR = 0.50; and rumination, χ2(1) = 12.95, p < .001, OR = 0.35. These findings suggest the mechanisms of MMB are consistent with the conceptual model for mindfulness-based cognitive therapy and depressive relapse risk and that such processes can be modified through digital delivery. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


The role of the interosseous membrane on tibiofibular weightbearing.
Three in vitro, strain gauge instrumented lower legs were loaded in positions ranging from 10 degrees dorsiflexion to 10 degrees plantarflexion with loads corresponding to those seen in normal gait. The interosseous membrane was found to play a critical role in the load-sharing ability of the fibula. After incision of the membrane, fibular strains decreased to essentially zero, thus supporting the hypothesis that the interosseous membrane acts as a conduit for stress transmission to the fibula. An intact membrane keeps the fibula active during the loads and motions of normal gait.


Knowledge of upper respiratory tract infection in elementary school children.
Children often acquire health and disease information from their parents; and, as a rule, parents of a higher socioeconomic status are often better educated than those of lower socioeconomic status. This study assessed children's knowledge of upper respiratory tract infection and correlated the level of knowledge with socioeconomic status, ethnic background and frequency of school absences. Twenty-two true-false questions were give to 331 elementary school children in grades two, four and six. Two schools were chosen because of differences in socioeconomic status of the prospective neighborhoods. The questionnaire was administered orally by one examiner while the children completed their own answer sheet. The higher socioeconomic status (SES) school had a correct mean score of 14.39, whereas the lower SES school had a mean score of 13.53. The mean correct score increased with grade level. White children had a mean correct score of 14.37, whereas non-white children had a mean correct score of 12.81. The mean correct score did not differ by sex. There was no correlation between mean correct score when compared to the students' claim of days missed from school because of upper respiratory infection. Students from both elementary schools appeared to have a general knowledge of etiology, symptoms, treatment and prevention of upper respiratory tract infection.


Prognostic value of nutritional and inflammatory markers in patients with hepatocellular carcinoma who receive immune checkpoint inhibitors.
The emergence of immune checkpoint inhibitors (ICIs) has provided a new treatment option for patients with hepatocellular carcinoma (HCC). However, further evaluation is needed for determining biomarkers for the use of ICIs. The present study evaluated the prognostic value of certain nutritional and inflammatory markers in patients with HCC who received ICIs. In the present study, the clinical data of 151 patients with HCC who received ICIs at Harbin Medical University Cancer Hospital from January 2019 to December 2021 were collected. The blood parameters of all patients before treatment were collected to evaluate certain nutritional and inflammatory markers, including the prognostic nutrition index (PNI), nutritional risk index (NRI), geriatric NRI (GNRI), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI) and advanced lung cancer inflammation index (ALI). Patients were grouped using the cut-off value calculated using receiver operating characteristic (ROC) curves, and the relationship between these biomarkers and prognosis was evaluated through survival analysis. Furthermore, the prognostic value of these biomarkers was assessed through multivariate Cox regression analysis and construction of nomograms. Finally, time-ROC curves were plotted to compare the differences in predicting prognosis between the biomarkers. In the preliminary survival analysis, all inflammatory and nutritional markers included in the present study were significantly associated with the prognosis of HCC in patients who received ICIs. Similar results were obtained in a subgroup analysis of patients with different Barcelona Clinic Liver Cancer (BCLC) stages. Multivariate Cox regression analysis demonstrated that GNRI, PNI, BCLC stage and Tumor-Node-Metastasis (TNM) stage were significantly associated with progression-free survival (PFS), whereas GNRI, BCLC stage and TNM stage were also significantly associated with overall survival (OS). Furthermore, the time-ROC curves indicated that nutritional indicators had a higher prognostic value in all indexes, especially GNRI. The C-index (95% confidence interval) of the nomograms for predicting the survival probability of patients who received ICIs were 0.801 (0.746-0.877) and 0.823 (0.761-0.898) for PFS and overall OS, respectively, which also showed high accuracy. In conclusion, the present study demonstrated that PNI, GNRI, NRI, SII, SIRI and ALI were all related to the efficacy of ICIs in HCC and could serve as non-invasive biomarkers for ICI treatment effectiveness. Moreover, compared with inflammatory markers, nutritional markers had greater predictive ability, with GNRI being the biomarker with the best prognostic value.


The impact of different communication and organizational strategies on mammography screening uptake in women aged 40-45 years.
Several factors can influence access to population breast cancer screening. The aim of the study was to evaluate the impact of different information approaches, women's socio-demographic characteristics and organizational factors on mammography screening uptake. We selected 5744 women aged 40-45 years who were randomly assigned to be given letters with: (i) a pre-fixed appointment plus standard leaflet (Group 1); (ii) a pre-fixed appointment plus a more comprehensive booklet (Group 2); (iii) point (ii) plus the offer of a counselling session (Group 3); and (iv) an invitation to contact the centre to get information and arrange participation (Group 4). Ninety-five women were excluded before the invitation and 5649 were randomized. After excluding undelivered letters (n = 41) and women reporting an exclusion criterion following our invitation (n = 248), the final eligible population was 5360 women. Participation rates following the first contact were 36.5, 39.9, 35.8 and 16.5% for Groups 1-4, respectively. The rates increased to 40.9, 43.6, 40.1 and 35.1% after the reminder letters. Women receiving more complete information had a higher uptake (Group 2), although not statistically significant. Differences among the four groups were maintained by controlling the effect of socio-demographic and attendance determinants. Regardless of intervention, participation was higher among married, higher educated, white-collared women, those born in northern Italy, living closer to the screening unit and with a female-collaborative doctor. Invitation letters with a fixed appointment correlate with a higher attendance rate. Providing women with more information on procedures, risks and benefits of mammography screening does not modify their participation.


Alpha lipoic acid attenuates radiation-induced thyroid injury in rats.
Exposure of the thyroid to radiation during radiotherapy of the head and neck is often unavoidable. The present study aimed to investigate the protective effect of α-lipoic acid (ALA) on radiation-induced thyroid injury in rats. Rats were randomly assigned to four groups: healthy controls (CTL), irradiated (RT), received ALA before irradiation (ALA + RT), and received ALA only (ALA, 100 mg/kg, i.p.). ALA was treated at 24 h and 30 minutes prior to irradiation. The neck area including the thyroid gland was evenly irradiated with 2 Gy per minute (total dose of 18 Gy) using a photon 6-MV linear accelerator. Greater numbers of abnormal and unusually small follicles in the irradiated thyroid tissues were observed compared to the controls and the ALA group on days 4 and 7 after irradiation. However, all pathologies were decreased by ALA pretreatment. The quantity of small follicles in the irradiated rats was greater on day 7 than day 4 after irradiation. However, in the ALA-treated irradiated rats, the numbers of small and medium follicles were significantly decreased to a similar degree as in the control and ALA-only groups. The PAS-positive density of the colloid in RT group was decreased significantly compared with all other groups and reversed by ALA pretreatment. The high activity index in the irradiated rats was lowered by ALA treatment. TGF-ß1 immunoreactivity was enhanced in irradiated rats and was more severe on the day 7 after radiation exposure than on day 4. Expression of TGF-ß1 was reduced in the thyroid that had undergone ALA pretreatment. Levels of serum pro-inflammatory cytokines (TNF-α, IL-1ß and IL-6) did not differ significantly between the all groups. This study provides that pretreatment with ALA decreased the severity of radiation-induced thyroid injury by reducing inflammation and fibrotic infiltration and lowering the activity index. Thus, ALA could be used to ameliorate radiation-induced thyroid injury.


Quality attributes of pistachio nuts as affected by rootstock and deficit irrigation.
In this work, the influence of two regulated deficit irrigation (RDI) treatments and three different rootstocks on the quality of pistachios was evaluated by analyzing different parameters: morphological analysis, physicochemical analysis and sensory analysis. The results obtained in terms of the choice of rootstock revealed that Pistacia atlantica had increased production yields, nut weight, mineral content, higher intensities of characteristic sensory attributes and a higher degree of consumer satisfaction, than the other rootstocks studied. Moreover, the results established that the application of RDI on pistachio cultivation had no significant influence on production yield, weight, size, colour, water activity or mineral composition. Furthermore, T1 treatment (stem water potential < -1.3 MPa) resulted in higher intensities of characteristic sensory attributes and a greater level of satisfaction among international consumers. These results confirm that the application of deficit irrigation (T1) contributes to an increase in overall product quality. Furthermore, Pistacia atlantica rootstock provided better yield and quality than the other rootstocks studied.


Role of dendritic cells in HIV-immunotherapy.
HIV remains one of the most important deadly infections today, due to the lack of a preventive vaccine and limited access to medical care in developing countries. In developed countries, antiretroviral therapy is available, but it can not eliminate the virus, implying that life-long therapy is necessary. Therefore, it is important that other strategies such as therapeutic vaccination will be developed to control virus replication or even eliminate the virus. The major obstacles towards such a strategy are the huge variability of the virus and the profound HIV-induced immune dysfunction. In this review we focus on dendritic cell based immunotherapies against HIV. To develop an efficient immunotherapy, several elements should be taken into account such as which antigen and loading strategy to use, how to deliver the immunogen, how to optimize the interaction between antigenic peptide and T cells and avoid tolerance. Clearly, to develop an immunotherapy to complement the effect of HAART, it is not sufficient to enhance T cell responses against a consensus sequence or against the prevailing plasma virus. Broad and potent immune response are needed to suppress the entire quasispecies, including the latent reservoir, and to prevent any escape.


National trends and disparate access to formal and informal sex education among youth involved with the child welfare system in the USA.
This study aimed to understand whether youth involved with the child welfare system in the USA are receiving formal and informal sex education. Data come from the Second National Survey of Child and Adolescent Wellbeing, a nationally representative sample of children and adolescents in contact with child protective services. Participants included young people (n=1093, aged 11-21) involved with the child welfare system. Participants reported whether they had received formal sex education about a) abstinence only; b) contraceptives/condoms only; c) abstinence and contraceptives/condoms; or d) none. They also reported whether they knew where to access family planning services. We examined the prevalence of sex education experiences and differences in sex education access and knowledge based on participants' pregnancy history and sociodemographic characteristics. Only half (49%) of participants had received any form of formal sex education. Pregnant youth were less likely to have received any sex education compared to non-pregnant youth (p=.045). 72% of adolescents who had received sex education about contraceptives/condoms reported knowing where to access family planning services compared to only 46% of adolescents who had not received sex education about contraceptives/condoms (p=.014). There is a pressing need for comprehensive sex education among young people involved with the child welfare system in the USA.


ISAR Imaging of Ship Targets Based on an Integrated Cubic Phase Bilinear Autocorrelation Function.
For inverse synthetic aperture radar (ISAR) imaging of a ship target moving with ocean waves, the image constructed with the standard range-Doppler (RD) technique is blurred and the range-instantaneous-Doppler (RID) technique has to be used to improve the image quality. In this paper, azimuth echoes in a range cell of the ship target are modeled as noisy multicomponent cubic phase signals (CPSs) after the motion compensation and a RID ISAR imaging algorithm is proposed based on the integrated cubic phase bilinear autocorrelation function (ICPBAF). The ICPBAF is bilinear and based on the two-dimensionally coherent energy accumulation. Compared to five other estimation algorithms, the ICPBAF can acquire higher cross term suppression and anti-noise performance with a reasonable computational cost. Through simulations and analyses with the synthetic model and real radar data, we verify the effectiveness of the ICPBAF and corresponding RID ISAR imaging algorithm.


Chromosome aberrations induced by clinical medicines.
Inducibility of chromosome aberrations of cultured mammalian cells was examined on 11 clinical medicines which are used for a long term mainly in the field of internal medicine. P-aminosalicilic acid, isonicotinic acidhydrazid, streptomycin A, hydralazine hydrochloride methimazole and theophylline induced definite increase of chromosome aberrations. Among them P-aminosalicilic acid was a little weak in its effect. The effects of rifamycin SV, aminophylline and isosorbide dinitrate were judged as suspicious, because only a slight increase of the aberrations were caused. Reserpine and propylthiouracil induced little chromosome aberrations. Effective concentrations of these medicines in our chromosome test were compared with their maximum blood concentrations in clinical use in human quoted from the published papers. Their ratios by isonicotinic acid hydrazid, streptomycin A, methimazole, theophylline and issorbide dinitrate were very high and those by others were relatively low. Because p-aminosalicilic acid, rifamycin SV, hydralazine hydrochloride and aminophylline were positive or suspicious in our chromosome test, further pursue for the safety evaluation seems necessary.


[Repair of the knee extension apparatus in the treatment of "extension contracture" after femoral lengthening].
Restriction of the knee flexion is one of the most frequent complications during femoral lengthening with Ilizarov method. In most severe cases the knee flexion reaches less than 90 degrees, which leads to impairment of patient's activity ("extension knee contracture") and represents difficult clinical problem to manage. We reviewed 4 patients at the age of 14 to 22 years (mean 19), treated surgically because of severe knee flexion limitation as a complication of femoral lengthening with the Ilizarov method. The mean age at femoral lengthening was 17 years (12 to 20). The indication for lengthening was femoral shortening from 5 to 12 cm (mean 7.5) because of myelodysplasia with club foot deformity (1 case), fibular hemimelia (1 case), sequelae of septic arthritis (1 case) and Ollier disease (1 case). Lengthening with Italian modification of Ilizarov device was used in all cases. In two patients with knee instability the apparatus was extended to stabilize the knee joint (in one case tibial and femoral lengthening was made simultaneously). Femoral lengthening of 5 to 12 cm (mean 7.5) was achieved. Knee flexion before lengthening varied from 90 degrees to 150 degrees (mean 135 degrees) and after femoral lengthening decreased to 41 degrees (20 to 75 degrees). Plasty of knee extension apparatus was done 16 months after removal of the Ilizarov device. The procedure includes extensive release of subcutaneous and fascial adhesions around the knee joint (4 patient), patellar retinaculum and ilio-tibial tract release (4 patient), lengthening of vastus lateralis muscle (4 patients), vastus medialis (2 patients) and vastus intermedius (1 patient), mobilization of patello-femoral joint (3 patients), fractional, intramuscular lengthening of rectus femoris 15 cm above the knee joint (2 patients). Intraoperatively 90 degrees flexion was achieved (80 degrees to 100 degrees). In after treatment plaster cast with knee flexion 45 degrees was used. After 4-5 days passive exercises were started using K2 apparatus (continuous passive knee motion) and posterior slabs: one with knee extension for walking and second with knee flexion at the night were used. Active exercises began at the 10th day after surgery. At follow up 10 to 47 months (mean 36) after surgery 105 degrees to 120 degrees of knee flexion (mean 114 degrees) was achieved with full passive and active knee extension at good muscle power. All joints were evaluated as stable in sagittal and coronal planes (including 2 joints with mild instability in coronal plane before surgery). 1. Femoral lengthening procedure should be realized with proper attention to prophylaxis of knee extension contracture. 2. Knee extension apparatus plasty is effective and save procedure for treatment of so called "extension knee contracture" as a complication of femoral lengthening.


How psychogenic is dystonia? Views from past to present.
In the last few centuries, there has been a constant sway between organic and psychogenic explanations for dystonia. In the current study, we investigate this history, assuming the perspective of a spectrum from organic to psychogenic, between which ideas were moving. We have focussed on (i) primary generalized dystonia, (ii) cervical dystonia, (iii) writer's cramp and (iv) fixed dystonia related to complex regional pain syndrome. We have studied medical texts published since the 19th century and their references. Jean-Martin Charcot advocated the concept of hysteria, disorders in which, besides predisposition, environmental factors were involved in their pathogenesis. Sigmund Freud introduced psychoanalysis as an explanatory therapy for psychic disorders. Previous theories, together with the lack of an organic substrate for dystonia, made a strong case for psychogenic explanations. Consequently, many dystonia patients were told that they suffered from psychological conflicts and were treated for them. However, after the description of new hereditary cases in the 1950s, the limited efficacy of psychotherapy in torsion dystonia, the effects of surgical treatments and the lesion studies in the 1960s, more physicians became convinced of the organic nature. The culminating point was the discovery of the DYT1 gene in 1997. In the meantime, experts had already convinced the neurological community that cervical dystonia and writer's cramp were focal dystonias, i.e. minor forms of generalized dystonia, and therefore organic disorders. In contrast, the pathophysiology of fixed dystonia related to complex regional pain syndrome remained controversial. Knowledge of this history, which played on the border between neurology and psychiatry, is instructive and reflects the difficulty in discriminating between them. Today, new insights from functional imaging and neurophysiological studies again challenge the interpretation of these disorders, while the border between psychogenic and organic has become more blurred. Abnormalities of sensorimotor integration and cortical excitability that are currently supposed to be the underlying cause of dystonia bring us back to Sherringtonian physiology. We suggest that this may lead to a common explanation of the four afflictions of which we have traced the history.


Intra-epithelial lymphocytes in the normal epididymis. A mechanism for tolerance to sperm auto-antigens?
Using a monoclonal immunoperoxidase technique on frozen tissue sections of normal testis and epididymis, a distinctive distribution of lymphocytes has been identified. Almost all of the intra-epithelial lymphocytes were T cells and the majority of these belonged to the T8+ ("suppressor/cytotoxic") subset. The distribution contrasted with the predominance of the T4+ ("helper/inducer") subset in the interstitial tissues and in normal peripheral blood. The predominance of the "suppressor/cytotoxic" subset within the epithelium of the epididymis may exist in order to prevent the development of the immune response to auto-antigens on spermatozoa.


[Recombinant allergens for specific immunotherapy].
Recombinant allergens for allergen specific immunotherapy are accepted in clinical practice. Some allergen variants and epitops have been presented as safety and effective methods influenced the pathomechanism of allergic process. Actual experience with recombinant allergens suggests us a new way in immunotherapy.


Protective effect of forsythiaside A on OVA-induced asthma in mice.
Forsythiaside A (FSA), an active constituent isolated from the Chinese medicinal herb Forsythia suspensa, has been known to have anti-inflammatory effect. However, the effect of FSA on allergic airway inflammation remains unclear. The aim of this study was to investigate the effect of FSA on OVA-induced asthma in mice. Mice model of asthma was induced by OVA. OVA-induced airway hyperresponsiveness (AHR) and inflammatory cells in BALF were detected. The production of IgE, IL-4, IL-5, IFN-γ, and IL-13 were detected by ELISA. The effects of FSA on Nrf2 and NF-κB signaling pathways were detected by western blot analysis. The results showed that treatment of FSA significantly attenuated OVA-induced lung histopathological changes. FSA inhibited OVA-induced AHR and inflammatory cells in BALF. OVA-induced IgE, IL-4, IL-5, and IL-13 production were also inhibited by FSA. Western blot analysis showed that treatment of FSA inhibited OVA-induced NF-κB activation. Treatment of FSA dose-dependently up-regulated the expression of Nrf2 and HO-1. In addition, we found that FSA up-regulated the expression of Nrf2 and HO-1 both in A549 cells and MS-H cells. Taken together, FSA suppressed inflammatory responses in OVA-induced asthma through activating Nrf2/HO-1 signaling pathway. FSA may be a promising potential preventive agent for asthma treatment.


[History of the Krefeld Dermatology Clinic].
The dermatology clinic in Krefeld has treated a wide range of patients since its founding in 1845. Nowadays the spectrum consists of allergology, occupational dermatology, phototherapy, dermatosurgery, phlebology and proctology as well as special clinics for andrology, sexually transmitted diseases and patients with HIV-infection.


Post-stroke depression: a critical review of the literature.
Because of its physical, psychological, interpersonal and financial repercussions, post-stroke depression is a sensitive issue facing patients, clinicians and society as a whole. The author highlights some difficulties with respect to research methodology, definition, etiology and treatment as reported in the recent scientific literature. Although this review challenges some notions about etiology and rates of post-stroke depression, suggestions are outlined to help prevent, recognize and treat this disorder, the incidence of which is expected to increase because of the demographic trend of our population towards aging.


Blocking factors against melanoma leucocyte-dependent antibody: relationship to disease activity in melanoma patients.
Previous studies have shown that many melanoma patients have cytotoxic leucocyte-dependent antibody (LDA) which is inhibited by factors in their sera. These factors were shown to be small molecular weight glycoproteins which could also be identified in the supernatants of melanoma cultures, and which were therefore most likely to be melanoma cell surface antigens. The present studies have shown that these blocking factors against melanoma LDA can be detected in patients with primary melanoma, and that the levels of this activity show an inverse correlation with the levels of LDA in the sera of melanoma patients. The appearance of melanoma LDA after surgery for localized melanoma was shown in approximately a third of the patients, and this pattern was shown to result from the disappearance of the LDA blocking activity after surgical removal of the melanoma. Assays were designed specifically to measure the melanoma LDA blocking factors by plasmapheresis. It is not yet known whether the melanoma LDA blocking activity has correlation with tumour growth in melanoma patients. The potential value of measuring this activity to assess response to therapy was shown by studies designed to remove the blocking factors by plasmapheresis. It is not yet known whether the melanoma LDA blocking activity has biological significance in regard to tumour growth, but these studies appear to indicate that measurement of these factors in the sera of melanoma patients may provide a useful in vitro monitor of tumour growth in melanoma patients.


Selenium in milk from feeding small supplements.
Supplements of 0, 1, 2, or 5 mg of selenium from sodium selenite fed per cow daily from 90 days prepartum through approximately 6 mo of lactation had no significant effect on selenium in milk of Hereford cows. Selenium in milk was assayed 2 to 3 days postpartum (average of .014 to .023 ppm) and approximately 3 mo post parturition (average of .016 to .021 ppm). The basal diet consisted of medium quality grass-legume hay (.069 mg/kg), ad libitum liquid supplement (.152 mg/kg), and 1.36 kg shelled corn (.018 mg/kg) starting in early lactation. Treatments of selenium were administered via free-choice liquid supplement.


Alanine aminotransferase 1 (OsAlaAT1) plays an essential role in the regulation of starch storage in rice endosperm.
Alteration of storage substances, in particular the major storage form starch, leads to floury endosperm. Because floury mutants have physical attributes for milling processes, identification and characterization of those mutants are valuable. In this study we identified a floury endosperm mutant caused by a T-DNA insertion in Oryza sativa alanine-aminotransferase1 (OsAlaAT1). OsAlaAT1 is localized in the cytosol and has aminotransferase enzyme activity. The osalaat1 mutant has less amylose and its amylopectin is structurally altered. OsAlaAT1 is predominantly expressed in developing seeds during active starch synthesis. AlaAT catalyzes the interconversion of pyruvate to alanine, and this pathway is activated under low-oxygen conditions. Consistently, OsAlaAT1 is induced by such conditions. Expression of the starch synthesis genes AGPases, OsSSI, OsSSIIa, and OsPPDKB is decreased in the mutant. Thus, our observations suggest that OsAlaAT1 plays an essential role in starch synthesis in developing seeds that are exposed to low concentrations of oxygen.


The use of palliative care to promote autonomy in decision making.
This article explores barriers to informed decision making in health care, and it proposes palliative care as one means of responding to the challenge of a widespread lack of autonomy in decision making. Through an exploration of research in the fields of autonomy and palliative care, the advantages of informed decision making and advance care planning by patients with advanced illness are discussed, and the implications for clinical practice and patient outcomes are described. Continuity, collaboration, and communication have a synergistic effect on autonomy. The expectation that the palliative care team will be in constant communication with the attending physician, nurses, and other specialists also promotes autonomous decision making. Patients who receive palliative care may have multiple advantages, including increased survival, improved quality of life, and opportunities for the exercise of autonomy.


Control of pulmonary metastases of rat mammary cancer by inhibition of uPA and COX-2, singly and in combination.
Tumor cell metastasis can be suppressed by the attenuation of proteolytic and angiogenic events that are mediated by tumor and endothelial cells. Combinations of specific inhibitors directed to separate stages of the metastatic cascade may improve the potential for adjuvant therapies. Amiloride is an effective plasminogen activator inhibitor, while celecoxib is a cylcooxygenase-2 inhibitor. In vitro invasion assays were used to assess the effect of each inhibitor on the cellular invasion of MATB rat mammary carcinoma cells. Individually, both amiloride and celecoxib impeded cellular invasion in a dose-dependent manner. Combinations consistently exerted a significant inhibitory response (91 to 99%). These inhibitors were administered alone and in combination to evaluate their efficacy in the prevention of pulmonary metastases from a primary rat mammary carcinoma. Amiloride and celecoxib, alone and in combination, consistently showed no effect on the growth of primary tumors. The combined inhibitors were able to reduce significantly the growth of local recurrences following primary tumor excision and metastatic incidence rates. Numbers of pulmonary metastases were reproducibly and significantly decreased with the administration of amiloride and celecoxib, alone and in combination. Celecoxib alone was most effective with a reduction in 98% of the metastases, yet distinctions were observed in the results with respect to the local recurrences, blood levels for the inhibitors and tissue production of prostaglandin E2. These data demonstrate the potential use for celecoxib, alone and in combination with amiloride, in the suppression of metastases.


The role of periostin in eosinophilic otitis media.
We investigated the localization of periostin in middle ear specimens from patients with eosinophilic otitis media (EOM) and from a newly constructed animal model for EOM. Periostin-positive immunostaining was observed in the middle ear sections obtained from the EOM patients. Immunoreactivity for periostin was also seen in the animal model. These results suggest that periostin plays an important role in subepithelial fibrosis in the middle ear in EOM. The purpose of the present study was to investigate the role of periostin in the middle ear of EOM patients and an animal model. Histological and immunohistochemical analyses for periostin were carried out in the middle ear specimens of six EOM patients with/without asthma. An animal model of EOM was constructed by intraperitoneal and topical sensitization with ovalbumin (OVA). Histological and immunocytochemical analyses for periostin were also performed in this model. Immunoreactivities for periostin were observed in the basement membrane and extracellular matrix of the middle ear sections obtained from all EOM patients with/without asthma. In the animal model, eosinophil infiltration and middle ear mucosa thickness were observed. Moreover, periostin-positive immunostaining was shown in the extracellular matrix of the middle ear mucosa on the side topically boosted by OVA.


First complete mitogenome of Axarus fungorum (Albu, 1980) from Guizhou Province, China (Diptera, Chironomidae).
Axarus fungorum (Albu, 1980) exhibits certain adaptations to different aquatic environments, appearing as an important evaluation element for freshwater quality monitoring. In this study, complete mitogenome of A. fungorum was provided for the first time to define the systematic and phylogenetic history of this taxon. The whole mitogenome is 15,696 bp long with high A + T content that consists of 13 protein-coding genes, 22 tRNA genes, two rRNA genes, and a noncoding control region. ML analysis showed support for monophyly of Chironominae and close relationship between A. fungorum and Chironomus generic genera.


Functional relationship between sealworm (Pseudoterranova decipiens, Nematoda, Ascaridoidea) burden and host size in Atlantic cod (Gadus morhua).
A model is proposed to describe the accumulation of sealworm parasites (Pseudoterranova decipiens, Nematoda, Ascaridoidae) in Atlantic cod (Gadus morhua). The model predicts the total amount of food eaten by a fish to reach its size. In young fish growth is linear in time and average parasite burdens are predicted to increase with the cube of the average length of the fish divided by its growth rate. An analysis of worm burdens in cod caught by the commercial fishery in the Firth of Clyde (Strathclyde, Scotland) between 1964 and 1970 illustrates how average parasite abundances at age, length, or fixed time of the year can be compared. It is concluded that exposure did not vary significantly over these years. Extensive apparent inter-annual variations in worm burdens of cod newly recruited to the fishery are well explained by differences in the age composition of cod catches.


Role of spectral domain optical coherence tomography in the diagnosis and prognosis of papilledema.
The study of papilledema with a novel noninvasive technique such as spectral domain-optical coherence tomography (SD-OCT) provides minute and detailed cross-sectional changes thus giving an insight into the application of biomechanical principles and pathophysiology of disc edema. We measured average retinal nerve fiber layer (RNFL) thickness and the retinal pigment epithelium/Bruch's membrane (RPE/BM) angle at the temporal and nasal borders of the neural canal opening (NCO) in 30 eyes with papilledema, 30 eyes with papillitis, and 80 control eyes. The inward angulation was considered as positive and the outward as negative. Follow-up was done at 1, 2, 3, and 6 months. The main outcome measures are the average RNFL thickness and the RPE/BM angle. 29 eyes (96.6%) with papilledema had a positive RPE/BM angle (+8.11 ± 3.13). 29 eyes (96.6%) with papillitis had a negative RPE/BM angle (-1.04 ± 3.27). On follow-up at 1 month, both RNFL thickness (P = 0.01) and RPE-BM angle (P = 0.001) reduced significantly in eyes with papilledema; in eyes with papillitis, there was a significant reduction in the RNFL thickness (P = 0.02), but not in the RPE-BM angle (P > 0.05). RNFL thickness in papilledema cases normalized at 3 months whereas RPE/BM normalized at 6 months of follow-up. To detect papilledema, OCT has a sensitivity of 96.66% and specificity of 99.09% on both nasal and temporal sides. After appropriate treatment, the RPE/BM angle in papilledema decreased much later than the RNFL thickness. Hence, the RPE/BM angle in papilledema (positive) can be used to differentiate it from papillitis (negative) and also to monitor the activity of the disease.


Isospectrality in chaotic billiards.
We consider a modification of isospectral cavities whereby the classical dynamics changes from pseudointegrable to chaotic. We construct an example where we can prove that isospectrality is retained. We then demonstrate this explicitly in microwave resonators.


Development of a novel biochip for rapid multiplex detection of seven mastitis-causing pathogens in bovine milk samples.
To efficiently prevent and treat bovine mastitis and minimize its effect on the dairy industry, a sensitive, rapid, and specific test is required for identifying the mastitis-causing pathogens. In this study, a biochip capable of detecting 7 common species of mastitis-causing pathogens, including Corynebacterium bovis, Mycoplasma bovis, Staphylococcus aureus, and the Streptococcus spp. S. agalactiae, S. bovis, S. dysgalactiae, and S. uberis, within 6 hr was developed. The technique is based on DNA amplification of genes specific to the target pathogens and consists of 4 basic steps: DNA extraction of bacteria, polymerase chain reaction, DNA hybridization, and colorimetric reaction. To examine the accuracy and specificity of this biochip, a preliminary test with 82 random quarter milk samples were analyzed and compared with results from conventional microbiological methods conducted simultaneously. Results from all but 1 sample analyzed by the biochip were in agreement with those analyzed by bacteriology. The biochip could be a feasible tool for rapidly diagnosing mastitis-causing pathogens in milk and providing information for a more effective treatment to cure mastitis.


Mischarging mutants of Su+2 glutamine tRNA in E. coli. I. Mutations near the anticodon cause mischarging.
In order to select the mischarging mutants of Su+2 glutamine tRNA, auxotrophic amber mutants of E. coli K12 which cannot be suppressed particularly by Su+2 were screened. By utilizing these mutants, cysam235 and metam3, several tens of mischarging mutants of Su+2 were isolated, as those conferring altered suppression patterns for a set of tester amber mutants of bacteria and phages. Nucleotide sequence analysis revealed that the mutation sites were found to be exclusively at psi 37 residue located at the 3'-end of anticodon loop, changing it to either A37 or C37. These mutants were obtained as those suppressing cysam235, and not metam3. From these, secondary mutants were selected. In these mutants suppression patterns were further altered by the additional base substitutions, capable of suppressing metam3. Such mutants were obtained exclusively from A37 and not from C37 mutant tRNA. Additional mutations to A37 were found to be either A29 or C38, which are located at the lowermost two base pairs in anticodon stem. The mischarging sites in Su+2 glutamine tRNA locate in the newly detected region of tRNA, differing from the previous case of Su+3 tyrosine or Su+7 tryptophan tRNAs. Implication of this finding is discussed on L-shaped tRNA molecule in relation to aminoacyl-tRNA synthetase recognition. Suppression patterns given by the double-mutants, A37A29 and A37C38, were consistent with the observation that the mutant tRNAs interact with tryptophanyl-tRNA synthetase.


Platelet Count and Mean Platelet Volume at the Time of and After Acute Myocardial Infarction.
Platelet count has been shown to be lower and mean platelet volume (MPV) to be higher in acute myocardial infarction (MI). However, it is not known whether these changes persist post-MI or if these measures are able to distinguish between acute thrombotic and non-thrombotic MI. Platelet count and MPV were measured in 80 subjects with acute MI (thrombotic and non-thrombotic) and stable coronary artery disease (CAD) at cardiac catheterization (acute phase) and at >3-month follow-up (quiescent phase). Subjects were stratified using stringent clinical, biochemical, histological, and angiographic criteria. Outcome measures were compared between groups by analysis of variance. Forty-seven subjects met criteria for acute MI with clearly defined thrombotic (n = 22) and non-thrombotic (n = 12) subsets. Fourteen subjects met criteria for stable CAD. No significant difference was observed in platelet count between subjects with acute MI and stable CAD at the acute or quiescent phase. MPV was higher in acute MI (9.18 ± 1.21) compared to stable CAD (8.13 ± 0.66; P = 0.003) at the acute phase but not at the quiescent phase (8.48 ± 0.58 vs 8.94 ± 1.42; P = 0.19). No difference in platelet count or MPV was detected between thrombotic and non-thrombotic subsets at acute or quiescent phases. The power to detect differences in these measures between thrombotic and non-thrombotic subsets was 58%. Higher MPV at the time of acute MI is not observed by 3 months post-MI (quiescent phase). Platelet count and MPV do not differ in subjects with thrombotic versus non-thrombotic MI. Further investigation is warranted to evaluate the utility of these measures in the diagnosis of acute MI.


Cross education of muscular strength during unilateral resistance training and detraining.
The purpose of the present study was to examine the changes in maximum voluntary isometric contraction (MVC) in the contralateral untrained limb during unilateral resistance training and detraining, and to examine the factors inducing these changes by means of electrophysiological techniques. Nine healthy males trained their plantar flexor muscles unilaterally 4 day-s x week(-1) for 6 weeks using 3 sets of 10-12 repetitions at 70-75% of one-repetition maximum a day, and detrained for 6 weeks. Progressive unilateral resistance training significantly (P < 0.05) increased MVC, integrated electromyogram (iEMG), and voluntary activation in the trained and contralateral untrained limbs. The changes in MVC after training were significantly correlated with the changes in iEMG in both limbs. No significant changes occurred in MVC, voluntary activation, and iEMG in the contralateral limb after detraining. The changes in MVC after detraining did not correlate with the changes in voluntary activation or iEMG in either limb. Training and detraining did not alter twitch and tetanic peak torques in either limb. These results suggest that the mechanisms underlying cross education of muscular strength may be explained by central neural factors during training, but not solely so during detraining.


Allodeterminants and evolution of a novel HLA-B5 CREG antigen, HLA-B SNA.
A novel HLA-B5 CREG gene, HLA-B SNA was cloned and the primary structure was determined. The sequence data showed that HLA-B SNA was identical to HLA-B51 except the alpha 1 domain in which one amino acid substitution at residue 74 and 5 amino acid substitutions associated with the Bw4/Bw6 epitopes were observed between these Ag. The comparison with other HLA-B locus genes suggested that HLA-B SNA evolved from HLA-B51 by gene exchange or recombination at the exon 2 between HLA-B51 and B8. A total of 10 of 14 HLA-B51-specific CTL clones showed significantly weak or no recognition of HLA-B SNA Ag. They also gave the same degree of a lysis of Hmy2CIR cells expressing the HLA-B35/51 chimeric Ag composed of the alpha 1 domain of HLA-B35 and other domains of HLA-B51 as that of Hmy2CIR cells expressing the HLA-B SNA Ag. These results demonstrated that amino acid substitutions within positions 77-83 associated with the HLA-Bw4/Bw6 epitopes have an influence on recognition of the HLA-B SNA antigen by HLA-B51-specific CTL.


Extracellular-Ca2+-Induced Decrease in Small Molecule Electrotransfer Efficiency: Comparison between Microsecond and Nanosecond Electric Pulses.
Electroporation-a transient electric-field-induced increase in cell membrane permeability-can be used to facilitate the delivery of anticancer drugs for antitumour electrochemotherapy. In recent years, Ca2+ electroporation has emerged as an alternative modality to electrochemotherapy. The antitumor effect of calcium electroporation is achieved as a result of the introduction of supraphysiological calcium doses. However, calcium is also known to play a key role in membrane resealing, potentially altering the pore dynamics and molecular delivery during electroporation. To elucidate the role of calcium for the electrotransfer of small charged molecule into cell we have performed experiments using nano- and micro-second electric pulses. The results demonstrate that extracellular calcium ions inhibit the electrotransfer of small charged molecules. Experiments revealed that this effect is related to an increased rate of membrane resealing. We also employed mathematical modelling methods in order to explain the differences between the CaCl2 effects after the application of nano- and micro-second duration electric pulses. Simulation showed that these differences occur due to the changes in transmembrane voltage generation in response to the increase in specific conductivity when CaCl2 concentration is increased.


The Lawrence D. Dorr Surgical Techniques & Technologies Award: Differences in Postoperative Outcomes Between Total Hip Arthroplasty for Fracture vs Osteoarthritis.
Hip fracture is an increasingly common expanded indication for total hip arthroplasty (THA) and warrants outcome analysis so as to best inform risk assessment models, public reporting of outcome, and value-based reimbursement schemes. The National Surgical Quality Improvement Program data file from 2011 to 2014 was used to identify all patients undergoing THA via current procedural terminology code 27130. Propensity score matching in a 1:5 fashion was used to compare 2 cohorts: THA for osteoarthritis and THA for fracture. Primary outcomes included Centers for Medicare and Medicaid Services (CMS) reportable complications, unplanned readmission, postsurgical length of stay, and discharge destination. χ2 tests for categorical variables and Student t test for continuous variables were used to compare the 2 cohorts and adjusted linear regression analysis used to determine the association between hip fracture and THA outcomes of interest. A total of 58,302 patients underwent elective THA for osteoarthritis and 1580 patients underwent THA for hip fracture. Rates of CMS-reported complications (4.0% vs 10.7%; P < .001), non-homebound discharge (39.8% vs 64.7%; P < .001), readmission (4.7% vs 8.0%; P < .001), and mean days of postsurgical hospital stay (3.2 vs 4.4; P < .001) were greater in the hip fracture cohort. THA for hip fracture was significantly associated with increased risk of CMS-reportable complications (odds ratio [OR], 2.67; 95% confidence interval [CI], 2.17-3.28), non-homebound discharge (OR, 1.73; 95% CI, 1.39-2.15), and readmission (OR, 2.78; 95% CI, 2.46-3.12). Our findings support recent advocacy for the exclusion of THA for fracture from THA bundled pricing methodology and public reporting of outcomes.


Bacillus thuringiensis membrane-damaging toxins acting on mammalian cells.
Bacillus thuringiensis is widely used as a biopesticide in forestry and agriculture, being able to produce potent species-specific insecticidal toxins and considered nonpathogenic to other animals. More recently, however, repeated observations are documenting the association of this microorganism with various infectious diseases in humans, such as food-poisoning-associated diarrheas, periodontitis, bacteremia, as well as ocular, burn, and wound infections. Similar to B. cereus, B. thuringiensis produces an array of virulence factors acting against mammalian cells, such as phosphatidylcholine- and phosphatidylinositol-specific phospholipase C (PC-PLC and PI-PLC), hemolysins, in particular hemolysin BL (HBL), and various enterotoxins. The contribution of some of these toxins to B. thuringiensis pathogenicity has been studied in animal models of infection, following intravitreous, intranasal, or intratracheal inoculation. These studies lead to the speculation that the activities of PC-PLC, PI-PLC, and HBL are responsible for most of the pathogenic properties of B. thuringiensis in nongastrointestinal infections in mammals. This review summarizes data regarding the biological activity, the genetic basis, and the structural features of these membrane-damaging toxins.


Nikolsky's sign on the gingival mucosa: a clinical tool for oral health practitioners.
Nikolsky's sign is a clinical sign which is elicited by a horizontal, tangential pressure to the mucosa and/or skin resulting in blisters extending and separating or peeling away. Few data are currently available in the literature about its usefulness, specificity, and sensitivity in the diagnosis of either oropharyngeal or cutaneous bullous diseases. The purpose of this study was to determine the sensitivity and specificity of the gingival Nikolsky's sign in the identification of an autoimmune blistering disease. Over a period of 13 years, we recruited 566 patients with autoimmune oral bullous and non-bullous diseases who possessed either maxillary or mandibular gingival mucosal lesions. All patients were subjected to a test causing a gingival Nikolsky's sign at their first visit during the diagnostic algorithm and in the active disease phase before commencing treatment. A total of 566 patients (184 with and 382 without bullous lesions) had at least gingival involvement. A positive gingival Nikolsky's sign resulted in 100 (17.7%) of 566 patients: 86 patients with bullous lesions (53 with pemphigus vulgaris, eight with mucous membrane pemphigoid, 22 with bullous/mixed lichenoid lesions, and three with erythema multiforme) and 14 with non-bullous lesions (12 with non-bullous lichenoid lesions and two with systemic lupus erythematous/mixed connective tissue disease). Thus, the specificity of Nikolsky's sign was higher (96.3%) than the sensitivity (46.7%). The results of this study support the use of Nikolsky's sign of the gingival mucosa as a viable test to establish the presence of oral bullous diseases.


General practice psychiatric clinics. Impact on psychiatric services.
The impact of devolving out-patient care to general practice (GP) psychiatric clinics over a two-year period is examined by comparing the frequency of contact with different psychiatric services in practices with and without psychiatric clinics. The clinics led to an increase in the number of outpatients seen, but to a fall in the number of new referrals. There was also a relative increase in the number of domiciliary visits and increase in acute day hospital referrals. The most important result was a 20 per cent fall in the number of admissions to the psychiatric hospital, which took place at a time when the national trend of falling admission rates was reversed. The findings suggest that psychiatric resources for in-patients can be deployed successfully in primary care without any increase in staffing.


Weightlessness and the developing frog egg.
This paper describes the results of the flight of fertilized frog eggs in the manned orbital flights Gemini 8 and Gemini 12. The experiment was designed to determine the effect of weightlessness or near weightlessness on the ability of the cell to divide normally and on subsequent differentiation and embryogenesis. Eggs were fixed periodically in flight so that recovered material could be carefully compared to simultaneous ground controls with respect to gross morphology and histology. Some embryos were recovered alive after 4 days in orbit. In general, no abnormalities were detected which were inconsistent with the controls. Death, shortly after recovery, of the embryos recovered alive in Gemini 12, remains unexplained. The protocol of the experiment and the experimental hardware is described. Rationale for future experiments is discussed.


Antibiotic prophylaxis in children with cancer or who have undergone hematopoietic cell transplantation.
Bacterial infections are common in children with cancer and can lead to life-threatening complications. Infections in these patients mainly occur during neutropenic periods, and may be caused by Gram-positive or Gram-negative bacteria. The patients at highest risk of serious infections include those with acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML), and those undergoing myeloablative hematopoietic cell transplantation (HCT). This is a review with the main aim of making a critical appraisal of the literature, and summarising what is currently known and can be recommended. The most significant studies support the use of floroquinolones (mainly ciprofloxacin) as the most rational approach to treat pediatric patients with probably long-lasting neutropenia, although trimetoprim-sulphametoxazole and amoxicillin/clavulanate may theoretically be valid alternatives. No prophylaxis seems to be needed for children with cancer without severe neutropenia. However, a global evaluation of the studies of antibiotic prophylaxis in children with cancer indicates that there are not enough data to prepare definite guidelines for its use or avoidance in pediatric oncology, and so further studies are needed. It is not only important to define the best antibiotic regimens for the children in whom such prophylaxis is useful, but also to identify precisely those who do not need it. This would avoid the antibiotic misuse that probably occurs at the moment because many low-risk children with cancer are treated. As prophylaxis against infections requires long-term adherence to an antibiotic regimen, the attitudes and beliefs of stakeholders need to be fully considered.


Association between Menopause, Postmenopausal Hormone Therapy and Metabolic Syndrome.
(1) Background: We aimed to explore the associations between menopause, postmenopausal hormone therapy, and metabolic syndrome in a large community-based group of Asian women. (2) Methods: This is a cross-sectional study in which we enrolled women aged 30 to 70 years with sufficient information about menopausal status from the Taiwan Biobank. The definition for metabolic syndrome used in this study aligns with the Bureau of Health Promotion's (Taiwan) proposed definition. (3) Results: A total of 17,460 women were recruited. The postmenopausal group had a higher metabolic syndrome prevalence (30% vs. 14%) and 1.17 times higher odds ratio (OR) than the premenopausal group (95% confidence interval [CI] = 1.02 to 1.33). Regarding the types of menopause, surgical menopause was associated with metabolic syndrome (OR = 1.40; 95% CI = 1.20 to 1.63); however, natural menopause was not associated with metabolic syndrome. Interestingly, postmenopausal hormone therapy was associated with a lower risk of metabolic syndrome in the women with natural menopause (OR = 0.79; 95% CI = 0.70 to 0.89), but not in those with surgical menopause. (4) Conclusions: Our results suggest that menopause is associated with an increased prevalence of metabolic syndrome, while postmenopausal hormone therapy is associated with a lower prevalence of metabolic syndrome in women with natural menopause.


Bis(imidazolin-2-iminato) rare earth metal complexes: synthesis, structural characterization, and catalytic application.
Reaction of anhydrous rare earth metal halides MCl(3) with 2 equiv of 1,3-bis(2,6-diisopropylphenyl)imidazolin-2-imine (Im(Dipp)NH) and 2 equiv of trimethylsilylmethyl lithium (Me(3)SiCH(2)Li) in THF furnished the complexes [(Im(Dipp)N)(2)MCl(THF)(n)] (M = Sc, Y, Lu). The molecular structures of all three compounds were established by single-crystal X-ray diffraction analyses. The coordination spheres around the pentacoordinate metal atoms are best described as trigonal bipyramids. Reaction of YbI(2) with 2 equiv of LiCH(2)SiMe(3) and 2 equiv of the imino ligand Im(Dipp)NH in tetrahydrofuran did not result in a divalent complex, but instead the Yb(III) complex [(Im(Dipp)N)(2)YbI(THF)(2)] was obtained and structurally characterized. Treatment of [(Im(Dipp)N)(2)MCl(THF)(n)] with 1 equiv of LiCH(2)SiMe(3) resulted in the formation of [(Im(Dipp)N)(2)M(CH(2)SiMe(3))(THF)(n)]. The coordination arrangement of these compounds in the solid state at the metal atoms is similar to that found for the starting materials, although the introduction of the neosilyl ligand induces a significantly greater distortion from the ideal trigonal-bipyramidal geometry. [(Im(Dipp)N)(2)Y(CH(2)SiMe(3))(THF)(2)] was used as precatalyst in the intramolecular hydroamination/cyclization reaction of various terminal aminoalkenes and of one aminoalkyne. The complex showed high catalytic activity and selectivity. A comparison with the previously reported dialkyl yttrium complex [(Im(Dipp)N)Y(CH(2)SiMe(3))(2)(THF)(3)] showed no clear tendency in terms of activity.